Guidelines of the French Society for Digestive Endoscopy (SFED).

or antiplatelet agents (APA) is a common problem before performing digestive endoscopy. Although risks concerning bleeding are the remit of both the gastroenterologist and anaesthetist, the potential risk of interruption of antithrombotic treatment for the patient should not be underestimated. Faced with the wide variety of situations, it is difficult to lay down rules which cover all circumstances and there are few reference guidelines [1 – 3]. Ideally, changes of treatment ought to be made in consultation with the doctor who initially prescribed the treatment with estimation of the risk/benefit ratio bearing in mind alterations to the antithrombotic treatment. This has to be tailored to individual patients on a case-by-case basis.This ideal situation is rare. Often the patient cannot remember the reference physician or the latter cannot be contacted. Other factors rendering such strategies difficult and complex include differences of opinion or lack of knowledge about the respective risks of stopping antithrombotic treatment or of not performing the endoscopy, lack of data in the literature, etc. However, in practice there are some data on which to base a decision. Three factors should be taken into account: the risk of haemorrhage from the procedure, the antithrombotic treatment used and the risk of thromboembolism when the treatment is withdrawn. In an attempt to reach the broadest possible consensus, the French Society of Digestive Endoscopy (SFED), the Study Group on Haemostasis and Thrombosis (GEHT) of the French Society of Haematology, the French Society of Cardiology (SFC) and the French Society of Anaesthesiology and Intensive Care Medicine (SFAR) have joined forces and put forward these recommendations. Of course, they are still only temporary guidelines and are likely to change over time as scientific knowledge accrues. There are few data in the literature about the risk of haemorrhage from procedures on patients taking antithrombotics. One may consider that antithrombotic treatment, which prolongs bleeding, increases the usual risk of haemorrhage by rendering symptomatic any bleeding that would have gone unnoticed in a patient with normal coagulation. However, antithrombotic treatment itself does not trigger bleeding. Therefore, when the risk of haemorrhage from a procedure is very low, antithrombotic treatment has little impact. In the absence of available data, three factors come into play when assessing the risk of a procedure on patients undergoing antithrombotic treatment: – When the risk of spontaneous haemorrhage from a procedure is already high (> 1 %), antithrombotic treatment is likely to increase …